In 1999 in an underground parking garage of a suburban Chicago office building, Integrating the Healthcare Enterprise (IHE) held its first Connectathon to demonstrate interoperability between health information technology (IT) systems and solutions. Twenty-three vendors testing forty-seven applications against one IHE Integration Profile marked the launch of IHE’s annual North American Connectathon.
Rob Horn, former IHE Co-chair remembers, “The place was cold. Mid-winter in Oak Brook, in RSNA’s [Radiological Society of North America] basement garage. It didn’t warm up much, until we got the computers running and people present.”
Lynn Felhofer was at that first IHE Connectathon as a vendor participant. She recalls, “There was “me, with my 90's hair, and Steve [Moore] with the same hair and glasses he wears today."
When asked about their “first Connectathon,” a number of IHE’s longstanding technical committee members actually refer to being involved in similar initiatives during the “early days” when they were developing specifications for the Internet or the first versions of the Digital Imaging and Communications in Medicine (DICOM) Standard.
John Moehrke’s first experience with the connectathon concept started “way before IHE existed.” He participated in connectathons hosted by Sun Micrososystems in the 80s and 90s, around the fundamental Internet protocols including: TCP, IP, ICMP, FTP, Telnet, SMTP, and NFS.” Similarly, Rob Horn’s experiences in interoperability testing started early. He said, “My first connectathon was Interop, in 1987, Crystal City, Virginia. But if you mean medical, then that would be the RSNA DICOM demonstration in 1992.”
By the time IHE IT Infrastructure Co-chair, Gila Pyke’s attend her first Connectathon, things were a bit further along. Gila said, “My first Connectathon was in Oak Brook in 2005, the last year it was held in the RSNA parking garage. My first impression was the most impressive chaos barley being held in check by the determined look on Steve Moore’s (IHE Connectathon Domain Technical Project Manager) face and an entire wall filled with enormous spreadsheets. The room we were in was massive, and packed with geeks from elbow to elbow, all of us looking a little overwhelmed and a little nervous.”
For many, their “most memorable” Connectathon experiences reflect the collegial spirit of the event. Venter remembers, “We stayed late one evening trying to help another developer fix his IHE XDS.b Profile (i.e, the IHE cross document sharing transactions profile). He had helped us with some other tests earlier in the day, and even though we had passed our XDS.b tests already, we stayed behind and helped him fix his transactions profile and tested it against our system until it passed.” He continued, “Although this is not a peculiarly funny or interesting anecdote, the almost ‘basement hacking’ experience, and the fact that this is a run-of-the-mill occurrence during Connectathon left a strong impression [on us].”After the IHE Connectathon moved to the Hyatt Regency Hotel in downtown Chicago in 2006, things got bigger and more automated every year. Hannes Venter, an engineer with Jembi Health Systems, a non-profit eHealth implementer based in South Africa, participated in his first Connectathon event in 2013. His impressions reflect 15 years of the event’s evolution and growth. He recalls, “I was first struck by how big it was. It was simply amazing to see the hotel basement filled with so many developers, and it was exciting to work in this type of environment. Despite being anxious about passing our tests or maybe even because of it, we quickly realized that everyone was there trying to accomplish the same thing.”
The collaborative spirit and informality of vendor interaction, particularly due to the contrast with the Connectathon event itself which is so well organized is what seemed to come to mind for other participants as well. Gila said one of her most memorable Connectathon stories was one of collaboration. Gila recalls, “The first year where the audit trail and note authentication or IHE ATNA Profile made TLS or transport layer security handshakes mandatory, a lot of vendors were struggling with getting the encryption to work. Even though my role there was as a monitor, I remember sitting down with someone from Initiate and then the two of us hashed out the openssl command line to get the handshake working. Bill Klaver, another Connectathon test participant then got up, printed the openssl line (this was before everyone had ready access to memory sticks) and walked over to a few vendors to let them copy it. I then watched, amazed, as those vendors, in turn, took copies of the working line of openssl code to other teams explained how to install and get it working. Within the afternoon, hundreds of vendors had passed the test.”
But, what is the impact of a Connectathon? What is its contribution to eHealth interoperability? On this topic, many cite the concept of a “safe place to fail.” For an excellent exploration of this aspect of a Connectathon, see John Moehrke’s blog post on the subject. In his blog, Rob extolls the fundamental importance of a venue “where vendors can work out their problems protected from the problems of customers, sales, marketing or other people getting in the way.”
Gila echoes this sentiment, and expands upon it, “Basically – providing that safe-to-fail environment where we can really test the viability of IHE Trial Implementation Profiles is one of the cornerstones of actual interoperability. It’s living proof-of-concept that spans dozens of vendors, and really helps to iron out any kinks in the way the Profiles were written, both from a technical perspective and in identifying unintentional ambiguities in the writing. Over the years, my own skills in developing standards have been significantly improved simply by seeing what implementers struggle with at Connectathon. On top of that, as someone who works to help healthcare providers implement IHE standards, the value of knowing in advance that software can meet certain basic requirements as established in IHE Profiles, and be conformance tested at Connectathon, is immense.”
Gila continues by stating, “Connectathons provide an enabling environment where eHealth interoperability gets ‘done’”. This is important, maybe vital, to supporting efforts to ‘bend the cost curve’ in the multi-trillion dollar domestic market. It is equally important in the low-resource settings in sub Saharan Africa, South East Asia, and elsewhere where IHE Profiles are being leveraged to help nascent national eHealth initiatives make important progress in improving the effectiveness of basic care delivery.
When asked about the biggest contribution of Connectathons, Hannes’ response was “good pragmatism.” He shared that, “The key is pragmatism. IHE in general feels to me like it sits somewhere in the middle between the ideals that standards strive for and the practicalities of a real-world system. The value is in showing that a particular profile actually works, and that your system has been through a hardening process before being used in live deployment. The Connectathon is an actualization of this.”
Hannes admits, “Although ‘hackathons’ are common, it isn't always default thinking when working on a project to bring together developers from various companies on neutral ground to test their systems.” After attending the Connectathon, he was inspired to host an informal mini-Connectathon for an ongoing interoperability project in South Africa. He said, “We invited several developers from the other companies involved over to our offices for interoperability testing and hacking (using standards based interfaces of course). This application of the connectathon idea was a great benefit to the project.”
In recent years, as healthcare systems around the world have begun to more strongly embrace eHealth and the call for broader interoperability grows ever louder, the need for the Connectathon increases in importance. Gila optimistically states, “In the last nine years, I’ve watched so many people and so much of their software evolve that it gives me hope for healthcare, in general.” In response to this growing need in health information technology and the positive results of these collaborations, the Connectathon bids a fond farewell Chicago and hello to its new, permanent home at the just-opened HIMSS Innovation Center in Cleveland, Ohio.
There have been many changes in the Connectathons held in Chicago over the last 16 years, since those first chilly days in the parking garage at RSNA headquarters to the massive Hyatt basement and now to the Innovation Center. And although there have been many improvements and new testing technologies from paper hanging on the wall to Kudu to Gazelle, Gila said she has come to appreciate the “little things” that don’t change such as, “seeing familiar faces returning year after year, and watching these participants transform from new-and-nervous to those seasoned veterans who take new participants under their wing.”
So mark your calendars for the IHE North American Connectathon 2015 being held at the HIMSS Innovation Center in Cleveland, Ohio from Jan 26 – 30, 2015. Unfortunately, something that isn’t changing is the cold Midwestern winter, but as in the first Connectathon in 1999, we know you will be kept warm by the great collaboration of those who will be there (and probably the computers too)!